Thank you for helping us with our research. If you are
under 18 please ask your parent or guardian to email us
their consent to take this test. Information
you provide is confidential and is used for H.E.A.R.'s research
purpose only. Please answer these questions to the best
of your ability.Thanks!

1. Do your ears ring after a concert?

Yes
No

2. Have you ever had trouble hearing conversation
after a concert?

Yes
No

3. Has anyone ever told you that you might have a
hearing loss?

Yes
No

4. What would you do in an overly loud situation?

5. Would you consider wearing hearing protection?

Yes
No

6. Are you a musician, dj or, someone who works in
the music business?

Yes
No

If yes, how long have you been a musician or working
in the music business field?

State occupation:

7. Do you play acoustic or amplified music?

Acoustic
Amplified
Both

8. What instrument do you play? (example: guitar,
turntables,rap/vocals)

9. When did you first notice that you might have tinnitus
(ringing ears) or a hearing loss? Please specify

10. Have you ever had your ears examined by an ear
doctor or your hearing checked by an audiologist?

Yes
No

11. Do you wear hearing protection while performing
music?

Yes
No

If not, why not?

12. Did your hearing loss ever make it difficult for
you to work?

Yes
No

13. Did your hearing loss ever cause you to lose or
quit your job?

Yes
No

14. Did your tinnitus ever make it difficult for you
to work?

Yes
No

15. Did your tinnitus ever cause you to lose or quit
your work?

Yes
No

16. Are attitudes changing about protecting your
ears from hearing damage from loud music and noise?

Yes
No

17. Which group is more effective in educating musicians
and teens about hearing loss prevention?